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ObjectiveTo investigate the influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury (IBDI). MethodsThe clinical data of 38 patients with IBDI were retrospectively analyzed. Of the 38 patients, the injury happened in 7 patients in our hospital while 31 patients were transferred in from other hospitals. We analyzed the previous operative records, the clinical manifestations of the patients, the radiological images and our operative findings in the definitive operations. According to the timing of the definitive operation, the patients were divided into the intraoperative repair group (n=26), the early repair group (n=15) and the delayed repair group (n=17). ResultsPatients in the intraoperative repair group had the best short-and long-term results, the shortest length of hospital stay and the lowest total cost. The early repair group, though having worse Results than the intraoperative repair group was still better than the delayed repair group. However, early detection of injuries and the ability to carry out timely corrective procedures depended on the availability of surgical expertise in the hospital. ConclusionsThe timing of definitive operation to provide corrective surgery to IBDI was a vitally important factor which affected prognosis.It is best to repair the injury within the same operation. The repair should be carried out by a doctor with ample experience in bile duct surgery.
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Objective To investigate the present status of casualty epidemiology in Zhengzhou and the effects of different trauma care model.Method Statistic study of the classification of emergency disease and the number of ambulance responses to the call in Zhengzhou emergency rescue center from January,2004 through December 2006 was carried out and the efficiency between the trauma care model of an inclusive emergency rescue survices station and that of a simple emergency survices station was analyzed.Results The percentage of ambulance departure responses by Zbengzhou emergency rescue center for trauma care was 45.3 %,44.7 % and 45.8% of in 2004,2005 and 2006,respectively.There were 26 emergency rescue service stationa in Zhengzhou, including one independent station,eight internal medicine dominated semi-independent stations and seventeen simple model stations.The indicated surgical intervention can lye performed on the patients with severe multi- trauma in the independent emergency station in order to win the optimal operation time and reduce the mortality. Conclusions The trauma is the major reason for the emergency call.Emergency rescue service stations properly distrihtted,can offer quick and efficient pro-hospital first aid.The independent emergency rescue service station can increase successful resuscitation rate of serious casualties.
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Objective To explore the possibility of early definitive operation for enteric fistulas. Methods In 37 selected enterocutaneous fistula patients, early definitive operation was performed during laparotomy for treating peritonitis within 10 days of fistula formation. Thorough irrigation of peritoneal cavity, effective sump drainage, fibrin glue sealant to reinforce anastomosis, appropriate nutritional support, and administration of growth hormone were key elements of perioperative management. Results Among 37 patients, 35 of them recovered uneventfully. Fistula recurred in 2 cases postoperatively; one fistula closed after conservative management, and another patient died of advanced gastric cancer 3 months postoperatively. The fistula operative closure rate was 94.5%. No operative death. Conclusion Advances in perioperative management can promote the success rate of early definitive operation for enteric fistulas. It may become a challenge to the present strategy of enteric fistula management.